위 종양의 내시경적 점막절제술 후 출혈의 위험인자
Risk Factors Related to Bleeding after Endoscopic Mucosal Resection of Gastric Tumors
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목적: 내시경적 점막절제술은 비교적 안전하고 비침습적인 시술로서 위점막종양의 진단 및 치료에 널리 이용되고 있다. 치료의 적응증이 확대됨에 따라 시술 후 합병증도 증가할 수 있다. 저자들은 점막절제술의 가장 흔한 합병증인 출혈의 빈도와 출혈과 관련된 위험인자를 연구하였다. 대상 및 방법: 본원에서 내시경적 점막절제술을 시행받은 249명 환자의 283개 병변을 후향적으로 분석하였으며 병변은 편평선종이 78.8%, 과형성용종 4.9%, 조기위암 16.3%였다. 출혈군과 비출혈군간의 출혈 위험인자분석과 더불어 시술 중 생긴 출혈을 조기출혈, 시술 다음날 시행한 추적내시경 검사상의 출혈을 지연출혈로 정의하여 빈도 및 위험인자를 단변량 및 다변량 분석하였다. 결과: 출혈의 빈도는 99예로 35%였으며, 조기출혈이 31.8%, 지연출혈이 7.1%였다. 출혈의 위험인자는 초심자(p＜0.001), 상부위(p=0.019), needle-knife를 사용한 경우(p＜0.001)였고 조기출혈의 위험인자 역시 초심자(p＜0.001), 상부위(p=0.011), needle-knife를 사용한 경우(p＜0.001)였다. 지연출혈의 경우 육안적 소견이 편평하거나 함몰된 경우(p=0.010)와 조기출혈이 있었던 경우(p=0.023)였다. 다변량 분석을 통한 출혈의 위험인자는 초심자(p=0.001), 상부위(p=0.018), needle-knife를 사용한 경우(p=0.001)였다. 결론: 내시경적 점막절제술에 있어 출혈을 방지하기 위해서는 시술자의 경험이 중요하며 병변의 위치, 시술방법에 유의하여 시술하여야 하겠다.
Abstract
Background/Aims: Endoscopic mucosal resection (EMR) has been widely used for treatment of gastric mucosal tumors because of its relative safety and minimal invasiveness. However, the bleeding after EMR has been regarded as a major complication. Herein, we assessed the bleeding rates and risk factors related to bleeding after EMR. Methods: We retrospectively analyzed the medical records of two hundred and fortynine patients with 283 lesions who underwent EMR for flat adenoma (78.8%), hyperplastic polyp (4.9%), and early gastric cancer (16.3%) from January 1999 to August 2003. Bleeding during EMR was defined as an immediate bleeding while bleeding on follow-up day endoscopy after EMR was considered as an delayed bleeding We evaluated risk factors related to bleeding using univariate and multivariate analysis. Results: Bleeding after EMR occurred in 99 patients (35%). Immediate bleeding occurred in 31.8% and was more frequent in the case of beginners, upper part of the stomach or EMR prcedures using needle knife. Delayed bleeding occurred in 7.1% and was more frequent in the case of flat or depressed lesions, or occurrence after the incidence of immediate bleeding. Risk factors related to EMR bleeding were experience of operator (beginner vs. expert, p= 0.001), anatomical location (upper vs. lower, p=0.018), and methods of procedure (needle-knife vs. snare or band, p=0.001). Conclusions: We concluded that experience of operator, anatomical location, and method of procedure were the risk factors related to bleeding after EMR.
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